Sasha Ayad, M. Ed., LPC

Gender & Sexuality

In 2014, I worked as a school counselor with low-income and at-risk youth. There, I founded and lead our first GSA, or Gay-Straight Alliance. It attracted students from multiple grade levels and the group was full of bright, creative, and engaged kids - truly inspired teens. I always tried to be watchful and nuanced when framing conversations because of how sensitive and impressionable teenagers are. I quickly noticed that the kids were expressing a lot of confusion. Specifically, they got into animated discussions about the growing list of divergent (and sometimes bewildering) gender identities and sexualities being introduced by mainstream LGBT advocates. I remember one meeting in particular: a girl told the group about a set of bracelets she had seen online. Each one is a different color, worn to supposedly indicate what gender you are "identifying as" that day - so others know what pronouns to use when addressing you. She seemed puzzled and asked us, “I mean, how exactly can you ‘feel like a boy, or a demi-girl, or non-binary'? Are they talking about emotions, like if I’m feeling kinda angry and aggressive, does that mean I’m identifying as a guy that day? Or like, what kind of clothes I am wearing?” Other students chimed in, agreeing, and we had a thoughtful and interesting conversation about what it could mean to have a “gender identity”. We couldn’t reach a satisfying conclusion, perhaps because “gender identity” isn’t as innate or fixed as we’ve been told. I can imagine an advocate of the “affirmative approach” might chime in and explain that all of our club members must have been “cis” and that’s why none of us could understand what it’s like to have a “gender identity”.

Interestingly enough, a few years later, the same girl who couldn’t even fathom the notion of gender identity, now suddenly has one herself - she identifies as a transboy. She has recently started “coming out” to loved ones and teachers. Apparent, she made this self-discovery after spending a lot of time online reading about “gender identity”, precisely because she didn’t understand it and wanted to know more. The iatrogenic nature of this cycle is inescapable, but mainstream medical and mental health organizations seem oblivious to this potentially causal relationship. Informally, this phenomenon - declaring oneself transgender for the first time around puberty after showing no signs of gender confusion as a child - has been termed Rapid Onset Gender Dysphoria.

I’ve spent the last six years trying to understand “gender identity”. I’ve read the literature and recommendations suggested by advocates of the “affirmative approach”. They argue that any declaration of a transgender identity, no matter how sudden or divergent from a child’s life-long disposition, must only be met with unquestioning acceptance and support, often followed by social and medical transition. However all of their approaches to treatment are based on one axiomatic supposition: that “gender identity” is fixed and innate. Perhaps more importantly, they assert that a cross-sex “gender identity” simply cannot develop in the context of exposure to, interest in, or public celebration of transgenderism.

Having spoken to hundreds families with trans-identified youth and to the kids themselves, I’ve had the informative opportunity to learn a different story. I’ve dedicated myself to careful and attentive listening, letting kids speak for (and think for) themselves. What I’ve discovered is that “gender identity”, as it’s defined, is vastly oversimplified and deeply underestimates the multidimensionality of all people, especially adolescents.

However, in the absence of ideology, therapy can escape the frenetic race towards drastic intervention. Instead, we create a safe exploratory environment for deeper listening and understanding - regarding the client as a whole, beautifully complex and growing person, rather than a unidimensional fixed identity. From this framework, the real “authentic self” can emerge. In giving voice to the struggle for individuality or community, unmet needs in relationships, or by nurturing confidence and resilience, important tasks of teenage-hood (and a myriad of others) may be resolved, making space for true self-acceptance.

Clients often conclude that their gender identity wasn’t really about having the “wrong body” after all. A client once told me something like this, “I think being trans was really about not liking myself and wanting to be someone else. I am so glad that you didn’t just send me off to get hormones, because I’m really happy now and I would have regretted transition. I have a lot of respect for you for taking things slow”. I was touched by this client’s willingness to be so introspective and recognize how other struggles had manifested for her, as a gender issue. However, is this really so surprising? After all, teenage-hood has always been characterized by deeply important and sometimes erratic attempts to navigate the conflicts and responsibilities of growing up.

Introspection, self-compassion, and movement towards wholeness are aspirational goals in any therapeutic relationship, and these are the focus of my practice. My work aims to help clients look beneath the literal interpretation of their incongruent feelings, giving them room to explore both their complexity and intuition. Each client is different, with a unique story to tell. For some, transition may be the best option. But for many others, resolving underlying issues can bring about an organic resolution to gender conflicts.